Chateter-associated Urinary Tract Infections in Adults
Received: 18 June 2013; Accepted: 05 August 2013 Conflict of interest: none declared. © AVICENA 2013 DOI: 10.5455/msm.2013.25.182-186
ORIGINAL PAPER
Mater Sociomed. 2013 Sep; 25(3): 182-186
Chateter-associated Urinary Tract Infections in Adults Dilista Piljic1, Humera Porobic-Jahic1, Dragan Piljic2, Sead Ahmetagic1, Rahima Jahic1 Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina1 Clinic for Cardiovascular Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina2 Corresponding author: Dilista Piljic, MD. Clinic for Infectious Diseases, University Clinical Center Tuzla. Trnovac bb, 75000 Tuzla. Bosnia and Herzegovina. Phone: +38735303335. Fax: +38735303480. E-mail: [email protected]. ABSTRACT Introduction: Hospital-acquired Urinary tract infections make 35% of all the hospital-acquired infections, and about 80% of them are related to the catheterization of the urinary bladder. Purpose: To determine clinical characteristics and dominant etiologic factors of Urinary Tract Infections associated with urinary catheter (C-UTIs). Methods: Determined clinical characteristics of C-UTIs were prospectively analyzed on 38 hospitalized patients in the Clinic for Infectious Diseases at the University Clinical Centre Tuzla, from January 1st 2011 to December 31st 2011. The control group constituted of 200 patients with community-acquired Urinary Tract Infections (Co-UTIs) hospitalized in the same period. Results: It was registered on 22 (57.89%) of symptomatic infections, 14 (36.84%) asymptomatic bacteriuria and 2 (5.26%) other C-UTIs. Dominant etiologic factors were: E. coli, caused 14 (36.84%), Extended-Spectrum Beta-lactamase producing (ESBL) Klebsiella pneumoniae 7 (18.42%), Enterococcus faecium and Candida spp. 3 (7.89%) of C-UTIs. E. coli was significantly most common etiologic factor of C-UTIs in younger women (p=0.04). E. coli from C-UTIS showed significantly higher resistance to antimicrobial drugs. Inadequate antimicrobial therapy was significantly more common prescribed to patients from C-UTIs. Lethal outcome was significantly most common associated with certain clinical and laboratory findings. Conclusion: Initial antimicrobial therapy of those serious infections should be based on data from those research. Key words: Urinary tract, infections, catheter.
1. INTRODUCTION Hospital-acquired Urinary Tract Infections (H UTI) present the UTI-s acquired in the hospital environment at least forty eight hours after the patient admission. It usually appears as a consequence of the invasive diagnostic and therapeutic treatments of the urinary tract (1). Those infections make 35% of all the hospital-acquired infections, and about 80% of them are associated to the catheterization of the urinary bladder, which is why they are also often named as a catheter-associated UTI (C-UTIs). Urinary tract catheterization increases the risk of bacteriuria, because of the bacteria´s tendency to adhere to artificial materials. Intraluminal infection direction is found in 23% of the C-UTI, as a consequence of the reflux of a numerous bacteria from the drainage bag. Extra luminal infection direction usually appears during the catheter placement, when bacteria from the periurethal area, or from the staff hands, impresses into the urinary bladder (3), or it can appear later when the bacteria migrates within the space between the catheter and urethral mucosa, which has been found in 35% of the patients (4). Prevalence of the infection increases with the catheterization period, if the catheterization period is short, it appears with 10-50% of the patients, and when the catheterization period is
182
longer it appears with practically all the patients (5). Only eight hours after the catheterization process, the inner and outer catheter surfaces contain a biofilm with bacterial cells, their polysaccharide glycocalyx, Tamm-Horfsfall proteins, struvite and apatite crystals and fibrin exudates of the damaged cells. Bacterias most frequently isolated within the biofilm are: Staphylococcus epidermidis, Enterococcus faecalis, E. coli, Proteus mirabilis, Pseudomonas aeruginosa and fungi (6). Uropathogenic E. coli which belongs to the fimbriae Type 3, is more frequently present in the biofilm (7). Bacteria in the biofilm change their phenotype, their cell involucre structure is different from other bacteria, their procreation is slower, antimicrobial therapy cannot effect them and the patient cannot defend from them (8). Antimicrobial resistance of the etiologic factors related to this infection, continuously increases, and it is different in some parts of the world, in some parts of one country, even in different sections of one hospital. However, those general recommendations for a their treatment should be in accordance with the local situation (9). Taking into account all the information previously mentioned the aim of those study was to analyze clinical characteristics and dominant etiologic factors of C-UTIs in the Clinic for Infectious Diseases Tuzla. ORIGINAL PAPER • Mater Sociomed. 2013 Sep; 25(3): 182-186
Chateter-associated Urinary Tract Infections in Adults
Comparison Total
Male
Female
F
Received: 18 June 2013; Accepted: 05 August 2013 Conflict of interest: none declared. © AVICENA 2013 DOI: 10.5455/msm.2013.25.182-186
ORIGINAL PAPER
Mater Sociomed. 2013 Sep; 25(3): 182-186
Chateter-associated Urinary Tract Infections in Adults Dilista Piljic1, Humera Porobic-Jahic1, Dragan Piljic2, Sead Ahmetagic1, Rahima Jahic1 Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina1 Clinic for Cardiovascular Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina2 Corresponding author: Dilista Piljic, MD. Clinic for Infectious Diseases, University Clinical Center Tuzla. Trnovac bb, 75000 Tuzla. Bosnia and Herzegovina. Phone: +38735303335. Fax: +38735303480. E-mail: [email protected]. ABSTRACT Introduction: Hospital-acquired Urinary tract infections make 35% of all the hospital-acquired infections, and about 80% of them are related to the catheterization of the urinary bladder. Purpose: To determine clinical characteristics and dominant etiologic factors of Urinary Tract Infections associated with urinary catheter (C-UTIs). Methods: Determined clinical characteristics of C-UTIs were prospectively analyzed on 38 hospitalized patients in the Clinic for Infectious Diseases at the University Clinical Centre Tuzla, from January 1st 2011 to December 31st 2011. The control group constituted of 200 patients with community-acquired Urinary Tract Infections (Co-UTIs) hospitalized in the same period. Results: It was registered on 22 (57.89%) of symptomatic infections, 14 (36.84%) asymptomatic bacteriuria and 2 (5.26%) other C-UTIs. Dominant etiologic factors were: E. coli, caused 14 (36.84%), Extended-Spectrum Beta-lactamase producing (ESBL) Klebsiella pneumoniae 7 (18.42%), Enterococcus faecium and Candida spp. 3 (7.89%) of C-UTIs. E. coli was significantly most common etiologic factor of C-UTIs in younger women (p=0.04). E. coli from C-UTIS showed significantly higher resistance to antimicrobial drugs. Inadequate antimicrobial therapy was significantly more common prescribed to patients from C-UTIs. Lethal outcome was significantly most common associated with certain clinical and laboratory findings. Conclusion: Initial antimicrobial therapy of those serious infections should be based on data from those research. Key words: Urinary tract, infections, catheter.
1. INTRODUCTION Hospital-acquired Urinary Tract Infections (H UTI) present the UTI-s acquired in the hospital environment at least forty eight hours after the patient admission. It usually appears as a consequence of the invasive diagnostic and therapeutic treatments of the urinary tract (1). Those infections make 35% of all the hospital-acquired infections, and about 80% of them are associated to the catheterization of the urinary bladder, which is why they are also often named as a catheter-associated UTI (C-UTIs). Urinary tract catheterization increases the risk of bacteriuria, because of the bacteria´s tendency to adhere to artificial materials. Intraluminal infection direction is found in 23% of the C-UTI, as a consequence of the reflux of a numerous bacteria from the drainage bag. Extra luminal infection direction usually appears during the catheter placement, when bacteria from the periurethal area, or from the staff hands, impresses into the urinary bladder (3), or it can appear later when the bacteria migrates within the space between the catheter and urethral mucosa, which has been found in 35% of the patients (4). Prevalence of the infection increases with the catheterization period, if the catheterization period is short, it appears with 10-50% of the patients, and when the catheterization period is
182
longer it appears with practically all the patients (5). Only eight hours after the catheterization process, the inner and outer catheter surfaces contain a biofilm with bacterial cells, their polysaccharide glycocalyx, Tamm-Horfsfall proteins, struvite and apatite crystals and fibrin exudates of the damaged cells. Bacterias most frequently isolated within the biofilm are: Staphylococcus epidermidis, Enterococcus faecalis, E. coli, Proteus mirabilis, Pseudomonas aeruginosa and fungi (6). Uropathogenic E. coli which belongs to the fimbriae Type 3, is more frequently present in the biofilm (7). Bacteria in the biofilm change their phenotype, their cell involucre structure is different from other bacteria, their procreation is slower, antimicrobial therapy cannot effect them and the patient cannot defend from them (8). Antimicrobial resistance of the etiologic factors related to this infection, continuously increases, and it is different in some parts of the world, in some parts of one country, even in different sections of one hospital. However, those general recommendations for a their treatment should be in accordance with the local situation (9). Taking into account all the information previously mentioned the aim of those study was to analyze clinical characteristics and dominant etiologic factors of C-UTIs in the Clinic for Infectious Diseases Tuzla. ORIGINAL PAPER • Mater Sociomed. 2013 Sep; 25(3): 182-186
Chateter-associated Urinary Tract Infections in Adults
Comparison Total
Male
Female
F
